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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 3  |  Issue : 1  |  Page : 1-5

Knowledge and practice of Ebola virus disease preventive measures among health workers in a tertiary hospital in Northern Nigeria


Department of Community Medicine, Ahmadu Bello University, Zaria, Nigeria

Date of Web Publication10-Oct-2018

Correspondence Address:
Dr. Ahmad Ayuba Umar
Department of Community Medicine, Ahmadu Bello University, Zaria
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/archms.archms_45_17

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  Abstract 

Background: Healthcare workers treating cases of Ebola virus disease (EVD) are at greatest risk of getting infected themselves. The risk increases when these workers do not have appropriate protective clothing or do not wear them properly or handle contaminated clothing incorrectly. This risk is particularly common in parts of Africa where health systems function poorly and where the disease mostly occurs. The study was carried out to assess the knowledge and practice of EVD preventive measures among health workers in a tertiary hospital in Northern Nigeria. Methodology: A cross-sectional survey was carried out using a self-administered, structured questionnaire, with a sample size of 80 health workers selected through multistage sampling technique. The data obtained were entered, cleaned, coded, and analyzed using IBM Statistical Package for the Social Sciences statistics 20. Results: All the respondents had heard of EVD, with 73% of them having good knowledge of the disease. Majority (62.2%) of the respondents had excellent knowledge of preventive measures of the disease. Positive attitude toward EVD preventive measures was demonstrated by 84% of the respondents. Only 41% of the respondents practiced hand washing all the time when attending to patients, 69% always used hand gloves for procedures which may involve contact with blood and body fluids, while 27% always used facemasks and goggles for procedures that may involve splashes of blood and body fluids, and 34% of the respondents, however, still practiced recapping of used needles. Conclusion: A third of the health workers still practiced recapping of needles, and very few health workers always use facemasks and goggles for procedures that may involve splashes of blood and body fluids. Management of tertiary hospitals should improve staff training on EVD preventive measures.

Keywords: Ebola virus, health workers, preventive measures, tertiary hospital


How to cite this article:
Umar AA, Sheshi MA, Sufiyan MB, Abubakar AA. Knowledge and practice of Ebola virus disease preventive measures among health workers in a tertiary hospital in Northern Nigeria. Arch Med Surg 2018;3:1-5

How to cite this URL:
Umar AA, Sheshi MA, Sufiyan MB, Abubakar AA. Knowledge and practice of Ebola virus disease preventive measures among health workers in a tertiary hospital in Northern Nigeria. Arch Med Surg [serial online] 2018 [cited 2018 Oct 19];3:1-5. Available from: http://www.archms.org/text.asp?2018/3/1/1/243036


  Introduction Top


Ebola virus disease (EVD), previously known as Ebola hemorrhagic fever, is a deadly disease caused by infection with one of the Ebola virus strains. Ebola can cause disease in humans as well as nonhuman primates (monkeys, gorillas, and chimpanzees).[1] Ebola outbreaks have occurred from time to time in Africa over the past 38 years. At present, there have been more than 19 additional outbreaks, primarily in Central African countries, with 2403 patients affected and with 1594 deaths (case fatality rate = 66.3%).[2]

EVD is spread between humans by direct contact with blood or body fluids of a person who has developed symptoms of the disease.[3] Body fluids that may contain Ebola viruses include saliva, mucus, vomit, feces, sweat, tears, breast milk, urine, and semen. Most people spread the virus through blood, feces, and vomit.[4] The World Health Organization states that only people who are very sick are able to spread Ebola disease in the saliva, and whole virus has not been reported to be transmitted through sweat.[4] Entry points for the virus include the nose, mouth, eyes, open wounds, cuts, and abrasions.[5] Ebola may be spread through large droplets; however, this is believed to occur only when a person is very sick.[5] This can happen if a person is splashed with droplets. Contact with surfaces or objects contaminated by the virus, particularly needles and syringes, may also transmit the infection.[6]

The virus is able to survive on objects for a few hours in a dried state and can survive for a few days within body fluids. The Ebola virus may be able to persist for up to 8 weeks in the semen of survivors after they recovered, which could lead to infections via sexual intercourse.[7] Dead bodies remain infectious; thus, people handling human remains in practices such as traditional burial rituals or more modern processes such as embalming are at risk.

Strict infection control measures and the proper use of personal protective equipment are essential to prevent transmission to healthcare workers. In addition, individuals who have been exposed to Ebola virus should be monitored so that they can be identified quickly if signs and symptoms develop. An effective public health response depends on effective communications between government authorities, medical professionals, and the local populace to explain the need for monitoring, sample collection and testing, isolation and other infection control measures, and the potential benefits of treatment.[2]

Healthcare workers treating those who are infected are at greatest risk of getting infected themselves. The risk increases when these workers do not have appropriate protective clothing such as masks, gowns, gloves, and eye protection; do not wear them properly; or do not handle contaminated clothing incorrectly.[7] This risk is particularly common in parts of Africa where health systems function poorly and where the disease mostly occurs.

It is imperative that healthcare workers must have adequate knowledge of EVD, how the disease presents, management of the disease, as well as preventive measures to be implemented in the prevention of the disease. Several studies have been carried out globally on various aspects of EVD. However, few studies exist locally on practices of healthcare workers in the prevention of EVD. This study was aimed at assessing health workers in a tertiary hospital in Northern Nigeria on various ways Ebola virus transmission could be prevented in the hospital, their attitudes to these preventive measures, and the level of implementation of these preventive measures.


  Methodology Top


Study area

Ahmadu Bello University Teaching Hospital is the largest health facility in the northwest geopolitical zone and serves as a referral center for the whole of Northern Nigeria. The University Teaching Hospital is comprised of 26 clinical departments which are manned by various cadres of dedicated clinical staff which includes doctors (made up of professors, consultants, residents, medical officers, and interns), nurses, pharmacists, and laboratory scientists.

Ahmadu Bello University Teaching Hospital functions as a training institute, as well as undertakes outpatient and inpatient care. Patients in Zaria metropolis and its environs invariably seek the services of the teaching hospital for complex medical problems which cannot be handled by primary and secondary health centers around. Similarly, the facility serves as a referral center, from which patients from all over Nigeria troop to access one form of services or the others. Most of the infectious disease cases are managed by the departments of medicine, pediatrics, microbiology, and hematology. This is in addition to the fact that most of the clinical departments have an infectious disease unit.

Study design and study population

A descriptive, cross-sectional survey was carried out to assess the practices of EVD preventive measures among clinical health workers in a tertiary hospital in Northern Nigeria. All clinical health workers who have not spent at least 1 year working and those not available at the time of data collection were excluded from the study.

Sampling technique

A multistage sampling technique was used to select the respondents. In the first stage, simple random sampling through balloting was used to select four out of 26 clinical departments, and departments of medicine, family medicine, microbiology, and pediatrics were selected. Simple random sampling by means of balloting was also used to select four out of 10 laboratories in the hospital; and based on this, general outpatient department laboratory, hematology laboratory; immunology laboratory, and microbiology laboratory were also selected. In the second stage, staff of the various departments were stratified based on their cadre, namely doctors, nurses, pharmacists, and laboratory scientists. The cadres were alloted 20 slots (25%) each of the 80 units of sample size. Then, through equal allocation, five respondents were selected from each of these cadres through simple random sampling (balloting).

Data collection tool and technique

A self-administered, structured questionnaire with closed-ended questions was used to collect data from the respondents. A research assistant was employed to distribute the questionnaires to each cadre of the healthcare workers.

Data analysis

The filled questionnaires were sorted, data coded, entered into, and analyzed using the International Business Machine (IBM) Statistical Package for Social Sciences (SPSS) Statistics, version 20.[8] Tables, graphs, and charts were used to present the results, and Chi-square test was used to determine relationships between categorical variables at P ≤ 0.05. A composite score was generated to assess the respondent's level of knowledge on EVD, and based on the 30 questions used to access knowledge, a respondent who correctly answers ≤10 questions was graded to have poor knowledge, those that correctly answered 11–20 questions were graded to have a fair knowledge, and those who correctly answered 21 questions or more were graded to have a good knowledge.

Another composite score was generated to assess the respondent's level of knowledge on EVD preventive measures, and based on the 17 questions used to access knowledge, a respondent who correctly answers ≤10 questions was graded to have fair knowledge, those that correctly answered 11–15 questions were graded to have a good knowledge, and those who correctly answered 16–17 questions were graded to have an excellent knowledge. A composite score was equally generated to assess the respondent's attitudes toward EVD preventive measures, and based on the four questions used to access attitude, a respondent who had a positive response to all four questions was graded to have a positive attitude, while those that indicated 3 or less were graded to have a negative attitude.

Ethical consideration

Ethical clearance was obtained from the Health and Ethics Committee of Ahmadu Bello University Teaching Hospital, Zaria. Informed consent was sought from the respondents before administration of questionnaires, and confidentiality of their responses was assured.


  Results Top


A total of 80 questionnaires were distributed to the health workers and 74 were completed and returned giving a response rate of 92.5%. The ages of respondents ranged from 24 to 62 years, with a mean age of 35.9 years. There was male preponderance with male-to-female ratio of 1.6:1. The duration respondents had practiced their professions ranged from 1 to 34 years, with a mean duration of 9.5 years. Over 42 (56%) of the respondents were married [Table 1]. Only 35% of the respondents had received training on EVD preventive measures, and duration of the training ranged from 1 to 21 days, with a modal duration of training of 1 day [Table 2].
Table 1: Sociodemographic characteristic of respondents (n=74)

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Table 2: Respondents training on Ebola virus disease preventive measures (n=74)

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Television was the most common (78.4%) source of information, closely followed by social media/internet (71.6%). Textbooks were the least (28.4%) source of information [Figure 1].
Figure 1: Respondents sources of information on Ebola virus disease

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Based on the score used to assess knowledge of EVD preventive measures, 62.2% of the respondents had an excellent knowledge of EVD preventive measures [Table 3]. Majority (85%) of the doctors had an excellent knowledge of EVD prevention, and this was followed by pharmacists with 64.7% having excellent knowledge [Table 4]. About 84% of the respondents had a positive attitude toward EVD preventive measures, while 16% had a negative attitude [Table 5]. More than 68% of the respondents reported using gloves always for procedures that may involve contact with blood and body fluids [Table 6]. About 27% of the respondents wore facemasks and goggles all the times for procedures which may involve splashes of blood and body fluids [Table 7].
Table 3: Knowledge score of respondents on Ebola virus disease prevention measures (n=74)

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Table 4: Cadre of health workers by knowledge score of the health worker on Ebola virus disease preventive measures

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Table 5: Respondent's attitude towards Ebola virus disease preventive measures (n=74)

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Table 6: Practice of glove-wearing by respondents for procedures which may involve contact with blood and body fluids (n=74)

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Table 7: Practice of facemasks and goggles-wearing by respondents for procedures which may involve splashes of blood and body fluids (n=74)

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  Discussions Top


Thirty-five point one percent, 35.1% of the respondents had received training on EVD preventive measures, and duration of the training ranged from 1 to 21 days, with a modal duration of 1 day. This shows that most of the trainings received by the respondents on EVD preventive measures were just a day's training which may not really be adequate.

All the respondents had heard of EVD from various sources mentioned. This is similar to the studies carried out by the Ministry of Health in Sierra Leone and Ministry of Health in Liberia, which both reported 100% level of awareness of EVD among the respondents.[9],[10] The most (78.4%) common medium indicated by respondents as their source of information on EVD was television. Social media and the internet also played a significant role in informing the respondents as 71.6% heard of EVD through it. About 19% of the respondents erroneously indicated that bats, monkeys, and other wild animals were the cause of EVD, and this finding may not be unrelated with the fact that social media, which was indicated as the source of information for about three quarters of the respondents always, associates the transmission of EVD with these wild animals. This is however not an isolated finding as 70% of the respondents interviewed by the Ministry of Health in Liberia and 74% of the respondents interviewed by the Ministry of Health in Sierra Leone indicated wild animals to be the cause of EVD.[9],[10]

For general knowledge on EVD, 73% of the respondents had good knowledge, and doctors had the highest proportion (85%) with good knowledge on EVD; this was closely followed by pharmacists with 82.4% having good knowledge, then nurses with 66.7% having good knowledge, and finally by laboratory scientists with 57.9% having good knowledge. This finding was however not statistically significant (P ≤ 0.05). These findings were similar to the findings obtained from a tertiary hospital in India, in which doctors had the highest proportion of those with good knowledge, followed by nurses, and least of all laboratory scientists.[11] Over 77% of the respondents who had received training on EVD preventive measures had a good knowledge of EVD as opposed to 71% of those who had not received training.

Up to 94% of the respondents had a good knowledge of preventive measures. This level of knowledge on preventive measures of the disease is impressive and is higher than the comprehensive knowledge of EVD preventive measures carried out by the Ministry of Health in Sierra Leone, which was found to be 39%.[10] However, that study was community based as opposed to the findings from this study which was carried out on health workers. Other studies carried out among health workers on the knowledge of preventive measures for EVD had variable findings, ranging from 42.7% of health workers in Sierra Leone having good knowledge[10] to 92% of health workers in the United States who were moderately informed about preventive measures.[12] Among the health workers, doctors had a higher proportion (85%) of excellent knowledge on EVD preventive measures, followed by the pharmacists with 64.7%. This finding was similar to the findings on the category of health workers with a good knowledge of EVD from a tertiary hospital in India, where doctors had a better knowledge of preventive measures.[11] Respondents who had received training on EVD preventive measures had a better knowledge of preventive measures when compared to those who had not received training, as 73.1% of those who received training had excellent knowledge, as opposed to 56.3% of those who had not received training. Statistically, however, this finding was not significant (P ≤ 0.05).

About 84% of respondents had a positive attitude toward EVD preventive measures, and this finding was similar to that of a study carried out by the Ministry of Health in Sierra Leone, which reported that 85% of health workers had a positive attitude toward EVD preventive measures.[10] Nurses had a higher percentage of respondents with a positive attitude toward EVD preventive measures compared to other cadres in the hospital, and this is similar to the finding from a tertiary hospital in India.[11] Eighty-six percent of the respondents reported hand washing when attending to patients. This finding was low compared to what was reported by the Centre for Public Study Alternatives which carried out a study in Lagos, Nigeria, and found out that 98% of the health workers practiced hand washing in between patients.[13] However, it should be noted that the study in Lagos was carried out during the peak of the EVD scare in Nigeria and as such the practice of hand washing was bound to be higher among health workers.

Up to 34% of the respondents still practice recapping of needles after giving injections. This finding was similar to a study carried out in a tertiary hospital in India, where 40% of the respondents reported recapping of needles. In another study in Abeokuta, Ogun state, Nigeria, it was found out that 32% of the respondents practiced recapping of needles.[14] Over 91% of respondents disposed of used “sharps” safely in sharp boxes. This is similar to the finding from a hospital study in India, where 90% of the respondents practiced safe disposal of sharps.[11] Only 69% of the respondents used gloves always when performing procedures that may involve contact with blood and body fluids. This finding is similar to a study carried out in Ogun state, Nigeria, where 64% of respondents used gloves always for invasive procedures,[14] but lower than the finding from Lagos in which 91% of the respondents used gloves always for invasive procedures.[14] Only 27% of respondents used facemasks and goggles always for procedures that may involve splashes of blood and body fluids, while 20% had never used these protective equipment. A similar result was obtained from Abeokuta in Ogun state, Nigeria, where 56% of respondents had never used facemasks or goggles for procedures that may involve splashes of blood and body fluids.[14]


  Conclusion Top


All the health workers had heard about EVD, and majority of them had a positive attitude towards EVD preventive measures. A third of the health workers still practiced recapping of needles, and very few health workers always use facemasks and goggles for procedures that may involve splashes of blood and body fluids. The management of tertiary hospitals should improve staff training on EVD preventive measures.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
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2.
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Funk DJ. Ebola virus disease: An update for anesthesiologists and intensivists. Can J Anaesth 2014;10:257.  Back to cited text no. 3
    
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Donald GMJ. Ask Well: How Does Ebola Spread? How Long Can the Virus Survive? New York Times; 620 Eighth Avenue, New York, NY 10018, 2014.  Back to cited text no. 4
    
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Centres for Disease Control. Q&A on Transmission. Ebola: Centres for Disease Control; 2014.  Back to cited text no. 5
    
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Chowell G, Nishiura H. Transmission dynamics and control of Ebola virus disease (EVD): A review. BMC Med 2014;12:196.  Back to cited text no. 6
    
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WHO. Ebola Virus Disease Fact Sheet. West African Ebola Outbreak-Key Events: World Health Organization; 2014. Available from: http://www.who.int/news-room/fact-sheets/detail/ebola-virus-disease. [Last accessed on 2014 Oct 25].  Back to cited text no. 7
    
8.
IBM. Statistical Package for Social Sciences, Statistics version 20. International Business Machine Corporation, 1 New Orchard Road, Armonk, New York 10504-1722. USA 2011.  Back to cited text no. 8
    
9.
Edward T, Liberty RS, Rudi SV, Francis FW, Daniel FK, Reginald F, et al. National Knowledge, Attitudes and Practices (KAP) Study on Ebola Virus Disease in Liberia. Monrovia: Liberia Ministry of Health; 2015.  Back to cited text no. 9
    
10.
Mohammad B. Jalloh PS, Samuel AP, George S. Study on Public Knowledge, Attitudes, and Practices Relating to Ebola Virus Disease (EVD) Prevention and Medical Care in Sierra Leone. Freetown: Sierra Leon Ministry of Health; 2014.  Back to cited text no. 10
    
11.
Vailaya RC, Sudeep K, Sajid M. Ebola Virus Disease: Knowledge, Attitude, Practices of Health Care Professionals in a Tertiary Care Hospital. J Pub Health Med Res 2014;2:13-8.  Back to cited text no. 11
    
12.
Rolison JJ, Hanoch Y. Knowledge and risk perceptions of the Ebola virus in the united states. Prev Med Rep 2015;2:262-4.  Back to cited text no. 12
    
13.
Jaiyeola AF. Study on the Ebola Virus Disease (EVD) Knowledge, Attitudes and Practices of Nigerians. Vol. 4. Lagos: Centre for Public Policy Alternatives Newsletter; 2014.  Back to cited text no. 13
    
14.
Sadoh WE, Fawole AO, Sadoh AE, Oladimeji AO, Sotiloye OS. Practice of universal precautions among healthcare workers. J Natl Med Assoc 2006;98:722-6.  Back to cited text no. 14
    


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    Tables

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